ENGLISH SUMMARY: This is a literature study of co-occurence and connections between eating disorders and substance abuse. The object of this report is to give a presentation of relevant international studies of co-occurence and co-morbidity between eating disorders or disordered eating and use or abuse of various substances.
We have reviewed 55 clinical and community studies from 1986 to 2005, mainly from North America and Western Europe, as well as five reviews/reports and a number of theme articles. This report consists of eight chapters, including an introductory chapter. Chapter two describes substance abuse and eating disorders providing definitions, prevalence and instruments for measurement. The next five chapters are based on types of studies, all with introductory information about the studies, the samples, and the use of tests.
Chapter three includes studies of co-occurring problem behaviours among youth, focusing both on youth in general and on youth residing in treatment for either eating disorders or substance abuse. According to the community studies, there are links between dieting, bulimic behaviour and body dissatisfaction, on one side, and the use of cigarettes, alcohol and drugs (illegal substances) on the other among both boys and girls ages 10 to 20. The clinical studies demonstrate that young people in treatment for bulimia nervosa use more substances than young people in treatment for anorexia nervosa. Young people in treatment for substance abuse show more disordered eating than young people in general.
Community studies of adults include women aged 16 to 59. The topic is eating disorders/disordered eating in relations to tobacco, alcohol and drugs. Smoking shows some co-occurrence with eating disorders/disordered eating, body dissatisfaction, drive for thinness, ineffectiveness and social insecurity. To a larger extent than women in general, women with diagnostic bulimia or with bulimic disordered eating abuse alcohol and/or experience negative consequences of alcohol. The pattern is similar for the use of drugs.
Studies of adults in treatment for either eating disorders or substance abuse show that women in treatment for bulimia smoke more cigarettes, drink more alcohol and use more drugs and psychotropics (by self-prescription), than women in treatment for anorexia. Compared to prevalence numbers for women in general, women in treatment for bulimia seem to show a higher prevalence concerning use of tobacco, alcohol, drugs and psychotropics (by self-prescription). Among men and women in treatment for substance abuse, full-blown eating disorders (especially bulimia) or disordered eating is more prevalent than in others.
The included studies demonstrate that for adults, women constitute the majority of those with comorbid eating disorders and substance abuse, as they constitute the majority of those with eating disorders only. For youngsters we find an elevated frequency of eating disorders among boys, making the comorbid problem behaviours more equally distributed among the sexes. The connections between disordered eating and use of substances seem to a certain extent to be equally strong or stronger among boys than girls.
Women and men, girls and boys, suffering from both eating disorders and substance abuse, predominantly develop eating disorders first and substance abuse later. This is congruent with what we know about age of onset for each of the two disorders.
The last chapter of this report looks at various possible risks or reasons for the co-occurence between substance abuse and eating disorders. Dividing them into biological, psychological and cultural explanations, the biological explanations include brain impulses and circuits, genetics and physical development. The psychological explanations concern self-esteem, coping, addiction, traumas, and psychiatric diagnoses (especially major depression, anxiety and personality disorders). Cultural explanations include influence from peers and mass media. Brain physiology, impulsivity, self-esteem and additional psychopathology seem to be the most common type of explanations. The review of the articles also suggests that various factors can play together in the development of comorbid eating disorders and substance abuse, for instance as predisposing, eliciting and maintaining factors.
The included articles offer little advice on prevention and treatment but strongly recommend screening/testing for substance abuse when dealing with eating disorders, and vice versa. In Norway we face great challenges regarding documenting and prevention, developing of treatment models, and further research. There is an obvious scarcity of qualitative research and phenomenological knowledge in the field.